Shorter Rehabilitation Length Of Stay Research Articles

Hip fractures: A review of predictors affecting Functional Independence Measure, ambulation and rehabilitation length of stay during inpatient rehabilitation in Singapore General Hospital

Introduction: Osteoporotic hip fractures receiving surgery are common and early rehabilitation is needed in the acute hospital setting. In Singapore, many receive rehabilitation after hip surgery in a tertiary hospital, and various clinical variables may be predictors of functional outcomes. Methods: We retrospectively reviewed 68 patients who went through inpatient rehabilitation in Singapore General Hospital. The primary outcomes of this study were to identify predictors which affect Functional Independence Measure (FIM) efficiency and motor FIM gain at discharge. The secondary outcomes include predictors affecting ambulation distance at discharge and rehabilitation length of stay (RLOS). Results: Age, dementia and days from fracture to surgery are important predictors of FIM efficiency; age and FIM efficiency are important predictors of ambulation distance; and type of fracture is an important predictor of RLOS. Patients of age <75 (OR 2.419, p=0.002), absence of dementia (OR 2.570, p=0.045) and those who received surgery <3 days from fracture onset (OR 2.529, p=0.036) achieved greater FIM efficiency. Younger patients of age <75 (OR 23.177, p=0.030) and those with FIM efficiency of more than 7 points per week (OR 38.963, p=0.05) achieved greater ambulation distance at discharge. Type of hip fracture is an important predictor for RLOS, with neck of femur fracture patients having shorter RLOS (OR 7.186, p=0.005). Conclusion: Age, dementia, days from fracture to surgery and type of hip fractures are important predictors of early functional outcomes in inpatient rehabilitation setting.

Timing of Initiation of Rehabilitation After Stroke

Maulden SA, Gassaway J, Horn SD, Smout RJ, DeJong G. Timing of initiation of rehabilitation after stroke. Objective To study associations between days from stroke symptom onset to rehabilitation admission and rehabilitation outcomes, controlling for a variety of confounding variables. Design Observational cohort study of 200 consecutive poststroke rehabilitation patients in each of 6 inpatient rehabilitation facilities. Setting Six U.S. inpatient rehabilitation hospitals. Participants Patients (N=969) with moderate or severe strokes who had days from stroke symptom onset to rehabilitation admission recorded in their medical records. Interventions Not applicable. Main Outcome Measures Discharge total FIM, discharge motor FIM, discharge activities of daily living (ADL) FIM, and discharge mobility FIM scores, as well as rehabilitation length of stay (LOS). Results Fewer days from stroke symptom onset to rehabilitation admission was associated significantly with better functional outcomes: higher total, motor, mobility, and ADL discharge FIM scores, controlling for confounding variables. For severely impaired patients with stroke in case-mix groups (CMGs) 108–114, the relation was strongest, with F statistics greater than 24.1 for each functional outcome. For patients with moderately severe stroke in CMGs 104–107, fewer days from stroke symptom onset to rehabilitation admission was associated significantly with shorter rehabilitation LOS. Conclusions Fewer days from stroke symptom onset to rehabilitation admission is associated with better functional outcomes at discharge and shorter LOS.

Abstract 25: Aneurysmal Subarachnoid Hemorrhage and Traumatic Brain Injury: A Comparison of Rehabilitation Outcomes

Objective: To compare short-term functional outcome in persons with diffuse brain injury of different etiologies, aneurysmal subarachnoid hemorrhage (SAH) versus traumatic brain injury (TBI). Design: Cohort study with matched group comparison. Setting: Acute inpatient interdisciplinary brain injury rehabilitation unit of a level I trauma center. Participants: Included a total of 48 patients with brain injury during the study period (2002–2004). 24 consecutive admissions with nontraumatic SAH were identified. A matched cohort of 24 patients with TBI were selected from 133 TBI admissions during this period on the basis of age, acute hospital length of stay (LOS), gender, and total admission FIM score. As intended by the design, the groups were found equal on all matching variables (all P>.05). Interventions: Not applicable. Main Outcome Measures: Total discharge FIM score, rehabilitation LOS (RLOS), FIM gain, and FIM efficiency defined as FIM gain/RLOS. Results: The TBI group had a shorter RLOS (18.7d vs 25.9d, P=.04) along with a greater FIM efficiency (2.17 vs 1.37, P=.01). The TBI group displayed better efficiency on both the FIM motor scale (1.83 vs 1.19, P=.01) and the FIM cognitive scale (.33 vs .17, P=.03). No between-group difference was found for either total discharge FIM or FIM gain (both, P>.05). Conclusions: This study demonstrated that a group of patients with TBI receiving inpatient rehabilitation made more rapid functional gains than a group of SAH patients matched for age, gender, acute LOS, and admission functional level. Rehabilitation programs should anticipate slower recoveries in aneurysmal SAH patients compared with TBI patients of similar prognostic markers.

Impact of transfer delays to rehabilitation in patients with severe trauma

Sirois M, Lavoie A, Dionne CE. Impact of transfer delays to rehabilitation in patients with severe trauma. Arch Phys Med Rehabil 2004;85:184–91. Objective To measure the effect on rehabilitation outcomes of administrative delays in transferring patients from a level I trauma center to inpatient rehabilitation. Design Retrospective cohort study. Settings Level I trauma center and an inpatient rehabilitation center in Quebec, Canada. Participants A total of 289 patients with severe trauma admitted to inpatient rehabilitation from a level I trauma center between 1994 and 1999. Interventions Not applicable. Main outcome measures Length of stay (LOS) in rehabilitation, motor and cognitive function at discharge from rehabilitation, interruptions in rehabilitation, and disposition at discharge. Results Shorter administrative delays were associated with shorter rehabilitation LOS ( P<.01) improved cognitive function ( P=.02) and had a negative but statistically nonsignificant association with motor function at discharge. No effect was observed for rehabilitation interruptions or dispositions at discharge. Conclusions Transferring trauma patients more quickly to inpatient rehabilitation can affect rehabilitation outcomes positively. It can also lead to an economy of resource use in both acute and rehabilitation settings.

Spinal Stenosis Vs Traumatic Spinal Cord Injury: A Rehabilitation Outcome Comparison

Objective: Nontraumatic spinal cord injury (NT/SCI), which can occur secondary to spinal stenosis, has been shown to represent a significant proportion of individuals admitted for SCI rehabilitation. The objective of this study was to compare demographics and outcomes of patients with spinal stenosis-induced SCI (SS/SCI) with those with traumatic spinal cord injury (T/SCI) following inpatient rehabilitation.Design: This 7-year prospective review compared 81patients with SS/SCI and 102 patients with T/SCI admitted to an SCI rehabilitation unit with similar levels and completeness of injury. Main outcome measures included rehabilitation hospital length of stay (LOS), Functional Independence Measure (FIM) scores, FIM change, FIM efficiency, rehabilitation charges, and discharge rates to home.Results: Results indicate that, when compared with the T/SCI, patients with SS/SCI had a significantly (P < .05) higher mean age (64.1 years vs 44.4 years), were more often female (39% vs 20%), and tended to present with paraplegia vs tetraplegia (69% vs 46%) and with motor incomplete SCI vs incomplete SCI (100% vs 49%). When comparing etiologies of SCI within tetraplegic and paraplegic groups, results showed that individuals with tetraplegic SS/SCI had a significantly (P < .05) shorter rehabilitation LOS (25.7 vs 35.9 days), and lower FIM change (24.5 vs 32.5) and FIM efficiency (1.0 vs 1.3); however, no statistical differences were noted for discharge FIM scores and discharge to home rates. Individuals with paraplegic SS/SCI also had significantly lower FIM change (20.2 vs 28.7); however no significant differences were noted for rehabilitation LOS, charges, FIM efficiency, or discharge-to-home rates.Conclusions: The findings indicate that patients with SS/SCI present with less severe clinical impairments (motor incomplete and paraplegia) in comparison with patients with T/SCI. Clinically similar SS/SCI groups were noted to achieve rates of functional gain and community discharge comparable with T/SCI patients. Although patients with T/SCI achieved greater overall functional improvement, patients with SS/SCI had shorter rehabilitation LOS and lower rehabilitation charges. These findings have important implications for the interdisciplinary rehabilitation process in the overall management and outcome of individuals with NT/SCI.

Neoplastic versus traumatic spinal cord injury: An outcome comparison after inpatient rehabilitation

Objective: To compare outcomes of patients with neoplastic spinal cord compression (SCC) to outcomes of patients with traumatic spinal cord injury (SCI) after inpatient rehabilitation. Design: A comparison between patients with a diagnosis of neoplastic SCC admitted to an SCI rehabilitation unit and patients with a diagnosis of traumatic SCI admitted to the regional Model Spinal Cord Injury Centers over a 5-year period, controlling for age, neurologic level of injury, and American Spinal Injury Association impairment classification. Setting: Tertiary university medical centers. Patients: Twenty-nine patients with neoplastic SCC and 29 patients with SCI of traumatic etiology who met standard rehabilitation admission criteria. Main Outcome Measures: Acute and rehabilitation hospital length of stay (LOS), Functional Independence Measure (FIM) scores, FIM change, FIM efficiency, and discharge rates to home. Results: Patients with neoplastic SCC had a significantly ( p < .01) shorter rehabilitation LOS than those with traumatic SCI (25.17 vs 57.46 days). No statistical significance was found in acute care LOS. Motor FIM scores on admission were higher in the neoplastic group, but discharge FIM scores and FIM change were significantly lower. Both groups had similar FIM efficiencies and community discharges. Conclusions: Patients with neoplastic SCC can achieve rates of functional gain comparable to those of their counterparts with traumatic SCI. While patients with traumatic SCI achieve greater functional improvement, patients with neoplastic SCC have a shorter rehabilitation LOS and can achieve comparable success with discharge to the community.